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Pom A iz 4 NEBRASKA Lint NE 6880 (aon) ari-2508 SUATEMENT BEFORE COMPLETING THIS FORM NADC FORM C-2 READ THE FILING REQUIREMENTS ON PAGES. * ACCOUNTABILITY AND a a COMMISSION POTENTIAL CONFLICT =eOP 7 ks te 400 OF INTEREST VY 5 i 2 5 MUL 19 AN ‘not use this form. Use Potential Conflict of Interest Statement Form C-2A. with your immediate superior (if any) whenever a potential + Persons who fail to disclose a potential conflict of interest or |= An official or employee of the executive branch of state government or any other officiel or employee required :o : file Statements of Financial Interests must file this form if he or she hes @ potential conflict of interest Elected officials of school districts and elected officials of villages and cities (except Omaha and Lincoln) shouic File this Potential Confict of Interest Statement with the Nebraske Accountability and Disclosure Commission anc conflict of interest situation arises. ‘who otherwise do not comply with the law ere subj to penalties. TEM 1 NAME, ADDRESS AND TELEPHONE NUMBER Name Tielke Willian, J. Telephone No. 402-340-4610 Tast Fist aE Address 88154 483% Ave Atkinson Ne 68713, ‘STREET ADDRESS OR RURAL ROUTE it STATE __21P CODE TEM 2 | TITLE, AGENCY, ADDRESS, PHONE AND SUPERIOR Your Title _Holt County Supervisor ‘Agency _Holt Agency Pho: ne _ 402 336 1762 clerks office ‘Agency Address _ Holt County Court House Name of Immediate Superior ETAIL (Use POTENTIAL CONFLICT OF INTEREST IN Di ‘Date action is to be taken ar decision is to be made: Description of Potential Conflict: ‘Keystone } _| they do say they will pay me around 48,000.00 Title Ttem 7 Continuation, if necessary) XL pipeline has an easement to cross my land | have been fully paid fpr all damages end easements. But project is completed if | work well with them. PERSONS WHO MAY RECEIVE FINANCIAL BENEFIT OR DETRIMENT You Bes fx] Member of your Immediate Family: _ Julie A. Tielke NAME Business With Which You [_] Are Associated (See Definitions) NAME OF BUSINESS (ITEM 5 | NATURE OF FINANCIAL BENEFIT OR DETRIMENT _ ae Bounse after work is completed. RTOS ns Tie FOR MEMBERS OF THE LEGISLATURE ONLY ES if you will not abstain from acting on a matter state why, despite the potential conflict, you intend to vote or otherwise participate. tee its reo Es 1 wit A Fagen + ‘ Z ITEM7 | CONTINUATION ) This was completed July 18, 2019 after talking with Frank. William J Tielke Holt County Supervisor a eeeeeenenteeatnneniancnenenarerantrn (DATE) ce